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Multicenter experience with the antegrade fenestration and reentry technique for chronic total occlusion recanalization
Author(s) -
Azzalini Lorenzo,
Alaswad Khaldoon,
Uretsky Barry F.,
Agostoni Pierfrancesco,
Galassi Alfredo R.,
Harada Ribeiro Marcelo,
Filho Evandro Martins,
MoralesVictorino Neisser,
Attallah Antonious,
Gupta Ankur,
Zivelonghi Carlo,
Montorfano Matteo,
Bellini Barbara,
Carlino Mauro
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28941
Subject(s) - medicine , reentry , fenestration , lumen (anatomy) , surgery , occlusion , balloon , dissection (medical) , cardiology
Abstract Objectives We aimed to evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for chronic total occlusion (CTO) recanalization in a multicenter registry. Background Adoption of antegrade dissection/reentry (ADR) for CTO recanalization has been limited, and novel ADR techniques are needed. Methods AFR involves the balloon‐induced creation of multiple fenestrations between the false and true lumen. A targeted true lumen reentry is subsequently achieved with a low tip‐load polymer‐jacketed guidewire. Following the initial description and dissemination of AFR, patients undergoing AFR‐based CTO recanalization at nine centers were included in the present registry. Study endpoints were AFR success, procedural success, and target‐lesion failure (TLF) on follow‐up. Results We included 41 patients. Mean J‐CTO score was 2.5 ± 1.4. In 80.5% of cases, AFR was performed after failed antegrade wire escalation. Another ADR technique was used before AFR in one‐third of cases. AFR achieved distal true lumen reentry in n = 27/41 (65.9%) cases. In n = 14/41 (34.1%) cases with AFR failure, use of alternative techniques led to successful CTO recanalization in eight additional patients. The overall technical and procedural success rates were 85.4% and 82.9%, respectively. No AFR‐related complications were observed. One‐year TLF rate was 8.3% overall, with no differences between successful and failed AFR. Conclusions We report on AFR feasibility in a multicenter registry of patients undergoing CTO recanalization. We observed a moderate success rate, coupled with the absence of complications. Moreover, even a failed AFR attempt did not preclude the use of alternative techniques to achieve recanalization. Further studies should confirm and extend our findings.